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BNSSG Adult Joint Formulary
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Decisions 22nd October 2024

Decisions 22nd October 2024 

New Drug Requests 

Levosimendan (TLS Red)

  • under the advice of consultant intensivist only.

Morphine sulfate modified release tablets (TLS Red)

  • for refractory chronic cough only

Domperidone tablets (off label) (TLS Blue) 

  • after assessment and guidance from a trained professional skilled in breastfeeding support / after non-pharmacological measures have been tried to stimulate lactation.
  • To increase breastmilk supply (short course 10mg TDS for 7 days then a suggested reducing regimen such as 10mg BD for 7 days, then 10mg OD for 7 days, then stop.
  • See SPS guidance on Using domperidone for low milk supply
  • Local specialists will be developing a local guideline/ updating Remedy page for further information

Shared Care Protocols

Updated SCPs:

  • Testosterone gel for menopause

Traffic Light Status changes

Other Decisions

  • Chapter review: 2.4 Blood pressure conditions page
    Perindopril from TLS Blue to TLS Green.
    Hydralazine from TLS Green to TLS Blue (to reflect prescribing would not be a first line option).
    Bendroflumethiazide- added to formulary as TLS Blue to reflect historical prescribing, but initiation in new patients for hypertension is not recommended. 
    Removal of specific wording from indapamide (TLS Green).
    Felodipine- remove 'unable to tolerate amlodipine/lercanidipine'. 
    Please note, a local hypertension guideline is in development by trusts, further work/update to this page may take place as part of this workstream. 
  • Page update: 6.8 Sex Hormone Responsive Conditions
    Removal of product costs from page.
    Lenzetto (estradiol) transdermal spray and Bijuve (estradiol and micronised progesterone) tablets from TLS Green to TLS Blue in line with formulary definitions.
    Testosterone criteria amended to include emphasis on excluding biopsychosocial causes of low libido in postmenopausal women and changed biomarkers for baseline testing.
    Updated hyperlinks and statement on stock availability. 
  • Page update: 7.6.3 Vaginal atrophy
    Ovestin brand discontinued and removed. Generic estriol 0.1% cream remains available. 
    Criteria added to Imvaggis pessary. 
    Criteria amended for Ospemifene tablets
  • Page update: 12.3 Oropharynx
    Additions to mirror the 16.5 excess salivary secretions (palliative care) page and the hypersalivation pathway for completeness:
    Hyoscine hydrobromide (Tablet and Transdermal as Scopoderm TTS® Patch) (off-label use) TLS Green
    Amitriptyline (off label use) TLS Green.

For Noting

  • Minor update to methotrexate for dermatology SCP -UHBW dermatology contact details updated
  • Addition of new cream formulation of Calcipotriol / Betamethasone to Adults Formulary